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Leveraging EHR Data to Improve OR Operations: A
University Hospital Case Study
Session 5, February 12, 2019
Dr. Jordan Tannenbaum, MD - Saint Peter’s University Hospital
Mr. Sanjeev Agrawal, President and CMO - LeanTaaS
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Learning Objectives
About Saint Peters University Hospital
Challenges
Why We’re Here – Motivation
What We Did
Marketplace for Open Time
Customized OR Management
Scheduler Effectiveness
Results
Comparing Then and Now
Questions
Agenda
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1. Examine how Saint Peters increased OR access during
standard business hours for both new and existing surgeons
using data from their EHR
2. Review how Saint Peters increased accountability with
actionable, surgeon-centric utilization metrics, resulting in
significant improvement to their OR capacity management
3. Describe why adding visibility helped Saint Peters surgeons
better understand the “WHY” behind OR metrics
Learning Objectives
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New Brunswick, NJ
University teaching hospital
10 ORs in 1 location
600+ cases a month
100+ active surgeons
AllScripts Paragon
About Saint Peter’s University Hospital
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Expensive, “perishable” OR capacity
Poor access to available open time
Significant demand variability among block owners
Proactive scheduling team with manual processes
Minimal insight into data through EHR
Challenges in enforcing accountability for blocks
Challenges
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Each operating room minute
is worth $100 - $300
A 500-minute day is worth
$50,000 - $150,000
1% improvement is worth
$125,000 - $375,000 per
operating room per year
On average, for a 20
operating room hospital,
improving utilization 3% is
worth $15,000,000 per year
Why We’re Here - Motivation
OR Time Is Precious and
Never Available….
…Yet “Reserved Time” is
Left on the Table Each
Day.
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What We Did
Accountability
The current process
for right-sizing blocks
is broken… “Block
utilization” is not
actionable
Collectable time” is far
more surgeon-centric
and actionable
Visibility
Is reporting “admiring
the problem” or driving
decisions? Are
providers and
administrators
engaged in credible
data?
Becoming more data
and hypothesis-driven
and bring reporting into
the 21
st
century?
Accessibility
No such thing as a
perfect block allocation
- Block time will never
be used exactly as
planned…
How can we ensure
advance time release,
create visibility into
open time, and making
it simple to request
time “a liquid
marketplace for open
time”
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Transparency into open time for
surgeon clinics
Transparency into demand for
OR schedulers
Ability to release time with
proactive interventions
Marketplace for Open Time
Flexible, real-time
configuration to set
equipment and staffing
constraints to reflect
real availabilities
Effective use of robot
Increased Access
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Run fewer rooms than
you have
Enforce service line
maximum
Make robot rooms do
robot cases
Customized OR Management
Configurable for How You Run Your ORs
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Scheduler Effectiveness
The Right Tools for Your Schedulers
Centralize transaction
management
Establish an organized
audit trail
Enable OR schedulers
to hold time for special
needs (transplant, etc.)
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80
Blocks per Month
Requested
Results
30
Blocks per Month
Released
70%
Requests From
Surgeons Without
Block Time
15 days
Average Release
Proactivity
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Deep Visibility into Metrics
Adopting a Single Source of Truth
Formalized and
standardized set of KPIs
with goals
Comprehensive,
accurate, and timely
information
Deep drill-downs into
the data to granular
level
Ad-hoc hypothesis
testing with “Explorer”
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Open Marketplace as a
Recruitment Tool
Better Capacity
Identification for Tighter
Allocation
Diagnostic Insight into
Current State
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Multi-Channel Access
Engage Your Surgeons Anywhere, Anytime
Email Mobile
SMS Chat-bot
Web
Paper
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Access to performance
metrics on both mobile and
web platforms
Delight Providers
Surgeon-Centric Experience
Weekly text
summary of
personalized KPIs
“pushed” to
surgeons
Linked to the
mobile web
experience for
deeper
engagement
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Collectable Time made it
easier to take blocks away:
Surgeon-centric, defensible,
and actionable methodology
Enables conversations with
underperforming block
owners
High defensibility of data
mitigates back-and-forth for
quick decisions
Identify the right capacity, and
then put it to work.
Data-Driven Block Right-Sizing
Enforcing Accountability
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Large Contiguous
Portions of Unused
Time
Abandoned Time Releases Beyond a
Certain Threshold
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OR schedulers and clinic schedulers
dealt with fax, emails, calls, sticky
notes etc.
Clinic schedulers had no visibility into
true open time inventory
OR schedulers had no visibility into
true patient flexibility
No way for OR schedulers to request
or release block ownership in the
EHR
Then…
OR and Clinic Scheduling was a Manual, Cumbersome Process
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No mechanism to
broadcast open time
No way to release time
in EHR
No incentive or trigger to
release time
No way to track releases
Periop leadership relied
on paper notes to credit
surgeons for releases
Then…
Creating, Accessing, and Crediting Open Time is a Broken
Process
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Clinic schedulers now have full visibility into
open time, and can self-balance based on
patient flexibility
OR schedulers can now focus on managing
OR constraints and outlier cases
OR schedulers have visibility into most
demanded times to accommodate as much
volume as possible
An organized audit trail for scheduling
activities
Back-and-forth conversations significantly
reduced through digitization
…and Now
OR and Clinic Scheduling is a Highly Streamlined, Centralized,
Digital Process
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Statistics such as “request and release
proactivity” help the OR make data-
driven decisions to set policies
Transparency into transactional
activities from metrics such as release-
request fill rate helps identify
opportunities
Ability to easily monitor the
effectiveness of OR initiatives
…and Now
Scheduling statistics provide insights to guide decision-making
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Lack of reliable reporting directly from
EHR
Spent days each month on creating
metric spreadsheets that were manual
and error-prone
Definitions and goals were
decentralized
Data was not surgeon-centric
Information was disseminated through
email or paper, which was inconvenient
for busy surgeons
Then…
Poor Visibility Into Performance and Lack of Trust in Existing
Data Led to Surgeon Disconnect with Operational Reality
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Primary motivation for initial engagement
Definitions and goals are clearly
displayed on an interactive dashboard
Weekly text summary of KPIs linked to
a mobile web experience for deeper
engagement
Surgeons often interact, challenge, and
directly engage with the data
Surgeons are active participants in
having data-driven conversations about
their own performance
…and Now
Surgeons are Actively Engaging with Individual and
Institutional Data
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Challenging to synthesize block
utilization data in a timely manner
Inconsistent enforcement of block
policy
Block utilization was frequently
challenged by block owners
Limited physician involvement in
block management
Then…
Challenges in Repurposing Allocated Block Time
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OR Committee is able to make data-
driven decisions through the Collectable
Time methodology
Focus on large opportunities and
reusable portions of time
Repeatable and defensible logic that
accounts for flaws in block utilization
calculation
Easily generate customizable block
letters for actions taken
…and Now
Decision-Centric Approach to Block Right-Sizing
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Please complete the online session evaluation.
Questions
Jordan Tannenbaum, MD
VP/Chief Information
Officer and Chief Medical
Information Officer, Saint
Peter's Healthcare
System
Sanjeev Agrawal
President and CMO,
LeanTaaS
jtannenbaum@saintpetersuh.com sanjeev@leantaas.com